Linking weather and health outcomes: Examining the potential influences of weather factors and particulate matter pollution on adverse pregnancy outcomes in the Kavre district, Nepal.

INTRODUCTION: Adverse pregnancy outcomes (APOs) include stillbirth, preterm birth, and low birthweight (LBW). Studies exploring the impact of weather factors and air pollution on APOs are scarce in Nepal. We examined the impacts of prenatal exposure to temperature, precipitation, and air pollution (PM2.5) on APOs among women living in Kavre, Nepal. METHODS: We conducted a hospital and rural health centers-based historical cohort study that included health facility birth records (n = 1716) from the Nepali fiscal year 2017/18 through 2019/20. We linked health records to temperature, precipitation, and PM2.5 data for Kavre for the six months preceding each birth. A random intercept model was used to analyze birthweight, while a composite APO variable, was analyzed using multivariable logistic regression in relation to environmental exposures. RESULTS: The proportion of LBW (<2500 gm), preterm birth (babies born alive before 37 weeks of gestation), and stillbirth was 13%, 4.3%, and 1.5%, respectively, in this study. Overall, around 16% of the study participants had one or more APOs. Total precipitation (ß: 0.17, 95% CI 0.01 to 0.33, p = 0.03) had a positive effect on birthweight in the wetter season. Negative effects for mean maximum (ß: 33.37, 95% CI -56.68 to -10.06, p = 0.005), mean (ß: 32.35, 95% CI -54.44 to -10.27, p = 0.004), and mean minimum temperature (ß: 29.28, 95% CI -49.58 to -8.98, p = 0.005) on birthweight was also observed in the wetter season. CONCLUSION: A positive effect of temperature (mean maximum, mean, and mean minimum) and total precipitation on birthweight was found in the wetter season. This study emphasizes the need for future research using larger cohorts to elucidate these complex relationships in Nepal.

Climate change impacts on the health of South Asian children and women subpopulations - A scoping review.

Background and objectives: Climate change impacts are felt unequally worldwide; populations that experience geographical vulnerability, those living in small island states and densely populated coastal areas, and children and women are affected disproportionately. This scoping review aims to synthesize evidence from relevant studies centred on South Asia, identify research gaps specifically focused on children and women's health, and contribute to knowledge about South Asia's existing mitigation and adaptation strategies. Methods: A research librarian executed the search on six databases using controlled vocabulary (e.g., MeSH, Emtree, etc.) and keywords representing the concepts "vulnerable populations" and "climate change" and "health impacts" and "South Asia." Databases were searched from January 2010 to May 2020. Papers were screened independently by two researchers. Results: Forty-two studies were included, of which 23 were based in India, 14 in Bangladesh, and five in other South Asian countries. Nineteen studies focused on meteorological factors as the primary exposure. In contrast, thirteen focused on extreme weather events, nine on air pollution, and one on salinity in coastal areas. Thirty-four studies focused on the health impacts on children related to extreme weather events, meteorological factors, and air pollution, while only eight studies looked at health impacts on women. Undernutrition, ARI (acute respiratory infection), diarrheal diseases, low birth weight, and premature mortality were the major health impacts attributed to extreme weather events, meteorological factors, and air pollution exposure in children and women in the region. Conclusion: Extreme weather events, meteorological factors and air pollution have affected the health of children and women in South Asia. However, the gap in the literature across the South Asian countries concerning relationships between exposure to extreme weather events, meteorological factors, air pollution and health effects, including mental health problems in children and women, are opportunities for future work.

Inequalities in demand satisfied with modern methods of family planning among women aged 15-49 years: a secondary data analysis of Demographic and Health Surveys of six South Asian countries.

OBJECTIVE: To estimate educational and wealth inequalities in demand satisfied with modern methods of family planning (mDFPS). DESIGN: A secondary data analyses of Demographic and Health Surveys. SETTING: Six South Asian countries, Afghanistan (2015), Bangladesh (2014), India (2015-2016), Maldives (2016-2017), Nepal (2016) and Pakistan (2017-2018). PARTICIPANTS: Women aged 15-49 years. Primary and secondary outcome measures mDFPS was defined as married women aged 15-49 years or their partners, who desired no child, no additional children or to postpone the next pregnancy and who are currently using any modern contraceptive method. We estimated weighted and age-standardised estimates of mDFPS. We calculated the slope index of inequality (SII) and relative index of inequality (RII) as the measures of socioeconomic inequalities. RESULTS: A total of 782 639 women were surveyed. The response rate was 84.0% and above. The prevalence of mDFPS was below 50% in Maldives (22.8%, 95% CI 20.7 to 25.0), Pakistan (42.0%, 95% CI 39.9 to 44.0) and Afghanistan (39.1%, 95% CI 36.9 to 41.3), whereas Bangladesh had achieved 76% (75.8%, 95% CI 74.2 to 77.3). Both wealth and educational inequalities varied in magnitude and direction between the countries. Except in Nepal and Bangladesh, mDFPS wealth inequalities showed a trend of increasing mDFPS as we moved towards richer, and richest wealth quintiles that is, pro-poor (RII (0.5 to 0.9); SII (-4.9 to -23.0)). In India and Nepal, higher versus no education was in favour of no education (higher mDFPS among not educated women) (RII 1.1 and 1.4; SII 4.1 and 15.3, respectively) and reverse in other countries ((RII (0.4 to 0.8); SII (-10.5 to -30.3)). Afghanistan, Maldives and Pakistan fared badly in both educational and wealth inequalities among the countries. CONCLUSIONS: South Asia region still has a long way ahead towards achieving universal access to mDFPS. Diverse patterns of socioeconomic inequalities between the countries call for national governments and international development agencies to target the population subgroups for improving the mDFPS coverage.

Risk and Resilience: How Is the Health of Older Adults and Immigrant People Living in Canada Impacted by Climate- and Air Pollution-Related Exposures?

BACKGROUND: In the rapidly shifting Canadian climate, an ageing population, and increased migration, a greater understanding of how local climate and air pollution hazards impact older adults and immigrant populations will be necessary for mitigating and adapting to adverse health impacts. OBJECTIVES: To explore the reported health impacts of climate change and air pollution exposures in older adults and immigrant people living in Canada, identify known factors influencing risk and resilience in these populations and gaps in the literature. METHODS: We searched for research focused on older adults and immigrants living in Canada, published from 2010 onward, where the primary exposures were related to climate or air pollution. We extracted data on setting, exposures, health outcomes, and other relevant contextual factors. RESULTS AND DISCUSSION: We identified 52 eligible studies, most focused in Ontario and Quebec. Older people in Canada experience health risks due to climate and air pollution exposures. The extent of the risk depends on multiple factors. We found little information about the climate- and air pollution-related health impacts experienced by immigrant communities. CONCLUSIONS: Further research about climate- and air pollution-related exposures, health, and which factors promote or reduce resiliency in Canada's older adults and immigrant communities is necessary.

Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey.

BACKGROUND: Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study. METHODS: We used the Nepal Demographic and Health Survey (NDHS) 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p < 0.001. RESULTS: The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under 5 years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of the interval between birth and subsequent birth (IBBSB). The association between the children's birth order and the prevalence of undernutrition had strong statistical significance. Mother's age at marriage (p = 0.001), underweight mother, mother's education, father's education, wealth quintile, no exposure to mass media, children's age, and place of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9). CONCLUSION: The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

Household Air Pollution and Angina Pectoris in Low- and Middle-Income Countries: Cross-Sectional Evidence from the World Health Survey 2002-2003.

The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002-2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56-0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30-2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09-1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12-2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.